CF 121: Marketing, Chiropractic vs. PT, Nutrition, & Chronic Pain, HVLA and the T/L Junction

Today we’re going to talk about Marketing Evidence Based Chiropractic, we’ll talk about Chiropractic vs. PT, Nutrition & Chronic Pain, HVLA and the T/L Junction

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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Hey there cool kats and kittens…, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #121

Now if you missed last week’s episode , we talked about the best way for the TMJ and we talked about some more recent research on axial traction for lumbar disc herniations both protruded and extruded. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

Well, I’m recording this on Monday April 13th so just a few days before its release. Today is my first day back. Not to full time. Just emergency visits. The stuff people are suffering from. How’s everyone enjoying this pandemic? Me….not so much. I’m not enjoying my sleep. I’m stressed. I’m anxious about what my practice will look like in a month or 2 months. 

I’m a glass half full type of guy so I’m keeping faith and hope and optimism as the primary factors in my life right now. And, my wife to be honest. What a strong, smart, driven, and talented person. She completes me. For sure. 

Some parts of the world are starting to reach or surpass their curves. But it’s not life back to normal is it?I think I said last week, life will not return to normal until either a vaccine comes a long or an effective treatment so that the consequences of it just aren’t as severe. Right now, we don’t have either of those. 

But I do like good news. Good news has been limited lately but it’s there if we look. most people do very well with this bad bug. I don’ even think they know how many have had the damn thing. It’s probably been circulating in America since the Fall. You know you have patients or friends that swear they had this deal a few months ago. 

Hopefully some of the new antibody testing will shed some light on this for us. Wouldn’t it be nice if it turns out this thing is more widespread than we thought and maybe lots of us have been exposed and never knew it? That’d also mean the mortality is lower than previously thought> It’d still be scary but not as scary right?

Speaking of good news, while this podcast is based around research, marketing is one of my things as well. In fact, that’s how I got into the research, it was looking for things to help me formulate effective messages. When I found the research, I found my marketing message. Best thing about that, it never runs dry. 

I’ve always wanted to help others with their message and how they’re getting it out there. Keeping that in mind, during this lull in business due to the pandemic, I decided to try something different and invest my time instead of waste it. I’ve certainly had the time to invest as have most of us.

I did two episodes on marketing an evidence-based practice a few months ago and both of those episodes are among our most listened to, most popular episodes so I know there is value there and I know there’s an interest in the topic. 

Over the years, if I wanted to learn more about excel, I’d take a course over at If I wanted to learn more about marketing, udemy proved to be a valuable resource. If you’re not familiar with sites like Udemy or Teachable, you should go check it out. 

I haven’t really looked into what other chiropractors are using it for but I thought, if I wanted to offer a course, Udemy would be a good place to start. While I’m still building the course and adding content every week, it’s live and ready to go for those interested. If it’s not, it will be live in only a day or two. 

If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like. 

Just go to and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. See what you think. It’s my first online course to create so any feedback is appreciated. Over time, I’ll be updating the content and adding graphics, and things like that as I finish the initial bulk of the work and am able to revisit and re-work parts that could use it. Plus, I plan on responding to feedback and make any needed changes from there as well. 

Item #1

Let’s start with one called “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation” by Nima Khodakarami(Khodakarami N 2020) and published in the Department of Health Policy and Management, Texas A&M on 19 of December 2019. Sizzlin’ son of beezwax!

Why They Did It

They say low back is a pandemic. While that’s true, low back hasn’t shut down the entire globe so maybe not on the level of the pandemic we’ve been dealing with I’d say. They say it’s the most costly musculoskeletal condition in the US and I would add the most costly globally as well.

He says, “Some suggest that using physical therapy (PT) or chiropractic in the earlier stage of LBP reduces the utilization of expensive health services and lowers the treatment costs. Given that there are costs and benefits with each of these treatments, the remaining question is in a short period of time which of these treatments is optimal.”

How They Did It

A decision tree analytic model was used for estimating the economic outcomes.

What They Found

The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group. The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group.

Wrap It Up

Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months.

Fine and dandy. Short and sweet but when we look deeper beyond the abstract and into the discussion portion of the paper, he says it makes sense to make the comparison between the two professions because the two are the superior non-pharma strategies for treating LBP and we’ve both had our share of criticism. 

For example, they pointed out the adverse effects of x-ray imaging, which he says is essential for contemporary chiropractic. I say, “No it’s not.” In fact, less x-raying is essential for contemporary, evidence-informed chiropractic. 

On the other hand, he points out that a survey of PTs showed they believe their training hasn’t instilled them with the skill needed to successfully address and treat the multidimensional pain presentations seen in LBP. 

He says, “This study analyzed these two strategies and showed that in the short term, chiropractic care is a more cost-effective alternative compared to PT for the treatment of acute low back pain. Chiropractic resulted in a lower cost ($48.56) and higher daily adjusted life years (0.0043) than the PT over a one-month treatment period and five months follow-up. However, the marginal cost-effectiveness of chiropractic over PT suggests that both treatments were quite similar.

I may agree that both treatments are similar. Like it or not, the two professions are beginning to blur. That makes some chiropractors lose their damn minds and it doesn’t bother other chiropractors at all. It’s undeniable they’re blurring regardless. Our profession has been using manipulation and exercise/rehab for generations. The PTs have owned the exercise space and owned cultural authority surrounding it. Now they’re starting to manipulate. They’re mixing and matching. Just like us. 

That is unless you’re a philosophy-faith-based chiropractor. Then all of this talk makes you insane and you’re probably not listening to an evidence-based podcast anyway. 

Let me tell you a little cost differential I ran into a few years ago. I was halfway through a PI case and the patient just wasn’t responding. This was in the days before my orthopedic diplomat so skills were limited at that time. I decided I’d reach out and see if I could refer to a local PT and maybe they would be able to jumpstart this patient for me since I was having such a hard time. 

Well, in once week that PT ran up a bill over $7,000. We don’t mark up our charges for PI cases. We charge what we’d charge Joe Blow off the street. Otherwise, we’d have a dual fee schedule and I don’t look good in orange. Who the hell does really? Orange is a stupid color overall. Anyway, it would take me over 3 months to run up the bill they ran up in one week. 

I cannot say whether that’s usual and customary nationwide or worldwide but I can tell you that it cured me of ever sending another case to a PT. 

Some say why compare the two? Can’t we all get along? Blah blah blah. Of course we can. But we’re blurring but not yet completely blurred. As this researcher mentioned both are atop the musculoskeletal heap and comparison of the two is natural and, I’d argue, healthy. Especially when you are advocating for one of the two. Which I am indeed. 

Some PTs actually work for or work with, chiropractors. That’s good stuff and I promise the patients win in those cases but I’m here to tell you, most of us DCs don’t fit in that discussion and neither do most PTs. They still have the cultural authority in the medical community and we still look like we’re insane in the membrane because we have members of our profession out there still running them through like cattle convinced their boosting immunity rather than ensuring community spread of COVID-19. 

I’m sorry guys and gals. I hate it. But seriously. When your state board and your state association says “Acute/Emergency cases only at this time” and you’re still running them through like normal…..YOU are not following recommendations coming from people that know a lot more than you do and for me…..that smell a whole lot like dangerous arrogance.

Item #2

This one is called, “Immediate Effects and Associations Between Interoceptive Accuracy and Range of Motion After a HVLA Thrust on the Thoracolumbar Junction: A Randomised Controlled Trial” by Griffiths, et. al.(Griffiths F 2019) and published in the Journal of Bodywork and Movement Therapies in October of 2019. Pretty hot, pretty hot. Not steaming, but still smokin’.

Why They Did It

There is paucity in the literature regarding the role of interoceptive accuracy (IAc) at predicting the effectiveness of osteopathic techniques which increase spinal mobility when directed specifically at the thoracolumbar junction (TLJ).

You know, as a side note here, when research authors say, “There’s a paucity,” it just sounds like they’re scolding those that came before them. Lol. Maybe it’s just me. 

Anyway, here’s a term some may get hung up on. Interoceptive accuracy. I went and Google machined it for you and it is the process of accurately detecting and tracking internal bodily sensations and is an objective empirical measure of behavioral performance, and is distinct from subjective measures. So now you know and..knowledge is power.

The study aimed to explore whether a high velocity, low amplitude (HVLA) thrust of the TL junction would increase spinal mobility (measured through Range of Motion; ROM) and change Interoceptive accuracy. Also, whether baseline Interoceptive accuracy correlated with the post-ROM measures and change in ROM.

How They Did It

  • They had 21 asymptomatics and split them into three conditions 
  • They were split in a randomized order
  • The groups were
  • High velocity low amplitude manipulation of the TL junction
  • Sham with basic touch
  • A control group 
  • Before and after each intervention, the patients ROM was measured using an Acumar digital inclinometer
  • In addition, an ECG was used to measure pre and post condition Interoceptive accuracy. 

What They Found

  • There were significant increases in ROM for all conditions hwoever the high velocity low amplitude group had a significantly greater increase in ROM 
  • The HVLA thrust did not significantly change Interoceptive accuracy scores from pre to post intervention

Wrap It Up

HVLA thrust over the TLJ is a useful intervention for increasing spinal ROM

As if you didn’t know that but, it’s a new paper, it’s done by the osteopathic profession and it’s just more concrete to stand on. 

Item #3

Our last paper this week is called “Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review” by Elma, et. al(Elma O 2020). published in Clinical Medicine in March 2020. Holy smokin’ javelina, it’s too hot to handle. 

For those that don’t know, a javelina is a wild boar or pig found in south Texas. I didn’t just make up a word OK? 

Why They Did It

Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain.

How They Did It

  • This review was conducted following the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines
  • PubMed, Web of Science, and Embase online databases were searched
  • After screening titles and abstracts of 20,316 articles and full texts of 347 articles, 12 eligible articles were included in this review, consisting of nine experimental and three observational studies

What They Found

  • Seven out of nine experimental studies reported a pain-relieving effect of dietary changes
  • Additionally, protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold

Wrap It Up

The authors wrapped it up by saying, “Plant-based diets might have pain-relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relationship with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.”

In the actual conclusion of the body of the paper, there is quite a bit of admission that this paper is far from being the final say. So, don’t take it as the end. Just take it as the end of the beginning if you will. 

Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. 

Let’s get to the message. Same as it is every week. 

Key Takeaways


Remember the evidence-informed brochures and posters at

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!


Send us an email at dr dot williams at and let us know what you think of our show and tell us your suggestions for future episodes. 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 


We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 


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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger


Elma O, Y. S., Deliens T, Coppieters I, (2020). “Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review.” J Clin Med 9(3): 702.

Griffiths F, M. T., Edwards D, (2019). “Immediate Effects and Associations Between Interoceptive Accuracy and Range of Motion After a HVLA Thrust on the Thoracolumbar Junction: A Randomised Controlled Trial.” J Bodyw Mov Ther 23(4): 818-824.

Khodakarami N (2020). “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare 8(1): 44.

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